SUMMARY
Antidote Health's mission is to redefine healthcare by providing affordable, high-quality, accessible care and insurance products. The Customer Success Agent plays a key role in achieving this mission by delivering exceptional support to our health plan members, telehealth users, brokers, B2B customers.
We're seeking enthusiastic individuals with experience in healthcare customer service, particularly within the health insurance industry, to elevate and distinguish the customer experience. Our Customer Success Agents are responsible for delivering accurate, timely, and valuable information to members and customers, ensuring a seamless and compliant experience in a fast-paced inbound and outbound phone, chat, and email Customer Support Center.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Handles customer inquiries through calls, chats, and emails, acting as the main point of contact for support and resolving issues.
- Builds and maintains brand affinity by addressing questions, concerns, and complaints professionally while maintaining confidentiality in compliance with HIPAA guidelines.
- Interprets and explains Antidote HMO insurance plans, benefits, enrollment processes, claims, EOBs, PCP selection, and referral/authorization for medical services, prescriptions, and other ancillary services (dental and vision).
- Serves as an advocate between customers and network providers or other Antidote departments.
- Assists in conducting customer satisfaction surveys and reports (CAPHS, QHP Enrollee Survey).
- Processes premium payment and reconciles and corrects payment discrepancies.
- Manages and updates member information in the customer relationship management (CRM) database.
- Identifies, addresses, and documents member and customer complaints, grievances and appeals, determines the appropriate action, follows up to ensure resolution and monitors trends to optimize customer satisfaction and remediate recurring issues in accordance with NCQA and regulatory processes and timelines.
- Provides outreach calls to members and customers for issue resolution and follow-up.
- Processes voicemail returns.
- Provides support for member and broker portals.
- Coordinates translation services for members in accordance with Antidote’s Language Assistance Program.
- Attend 100% of trainings, and the first 90 days of employment.
- Performs other duties as assigned.
QUALIFICATIONS
The ideal candidates for this position are highly motivated and dedicated and should possess the below qualities:
- High school diploma or GED
- Minimum one (1) year of experience working in a call center in insurance managed care, with a preference for HMO experience
- Basic understanding and ability to apply Centers for Medicare and Medicaid (CMS) regulatory requirements and standard operating procedures.
- Excellent oral and written communication skills
- Strong organizational abilities and interpersonal skills
- Ability to work flexible schedules, strong analytical and problem-solving skills, and the ability to multitask effectively.
- Dependable in completing assignments and maintaining attendance
- Ability to type at a speed of 35-40+ WPM with an accuracy of 90% or higher.
- Intermediate to advanced skills in Microsoft Office (Word, Excel, Outlook), with the ability to troubleshoot and resolve general technical issues.
- Willingness to work any 8-hour shift schedules during business hours, with occasional overtime, weekends, and holidays as needed.
- Bilingual (English/Spanish) preferred.
- Experience in provider and facility credentialing is a plus.
WORK SHIFTS AVAILABLE
Shift flexibility is required. Shift availability is based on staffing needs, with no guaranteed shifts.
- Available shift options:some text
- Pre-shift: 6:00 AM - 2:30 PM EST
- Morning shift: 8:00 AM - 4:30 PM EST
- Mid-shift: 11:00 AM – 7:00 PM EST
- Evening shift: 5:00 PM - 1:00 AM EST
- Overnight shift: 1:00 AM EST – 6:00 AM EST
- Available days of the week:some text
- Sunday - Thursday
- Tuesday - Saturday
- Friday – Monday
CERTIFICATES, LICENSES, REGISTRATIONS
- A Health Agent license is a plus but not required.
WORK ENVIRONMENT
- This is a remote position.
- Must have a quiet, distraction-free workspace to perform duties effectively from home. Work location must be secure and private to maintain HIPAA compliance.
- To ensure Home associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Office equipment will be supplied.
TRAINING EXPECTATIONS
- You will attend a minimum 4-5 week remote training program.
- Attendance is mandatory for the full training program.
- Training hours: Monday through Friday, 9:00 AM - 4:30 PM EST
- You will be required to take regular open-book competency and retention exams during all weeks of training, with a passing grade of 90% or above.
- We request no time off within the first 120 days of employment except in emergencies.
